Comparing quality of care at community health centers and private practices

Here's some encouraging news in light of the U.S. Supreme Court decision to largely uphold the Affordable Care Act. New research from Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues shows government-funded community health centers, which the ACA depends on to provide services to previously uninsured patients, provide better care than private practices.

[Researchers] evaluated the physicians' adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. "We looked at fairly common conditions that are seen in primary care," said lead author L. Elizabeth Goldman, MD, of UCSF.

[They] found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures. For the remaining five measures -- use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients -- the community physicians followed recommendations a higher percent of the time.

Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, "The fact that community health centers look better is perhaps surprising."

"On the other hand, having worked in community health centers, I can see how it makes sense," he added. "These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care."

Stafford speculates that government funding for community heath centers to upgrade technology used in managing patient care and the fact that such health-care settings are larger, offering more opportunity for collaboration among physicians, may also help in explaining the findings.

The scenario many of us learned in school is that two X chromosomes make someone female, and an X and a Y chromosome make someone male. These are simplistic ways of thinking about what is scientifically very complex.